Am J Perinatol
DOI: 10.1055/a-2081-2986
Original Article

Clinical Factors Associated with Intrapartum Presentation Change after Mechanical Cervical Ripening

Gianna Wilkie
1   Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester, Massachusetts
,
Katherine Leung
1   Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester, Massachusetts
,
Julianne Lauring
1   Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester, Massachusetts
› Institutsangaben Funding None.
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Abstract

Objective The use of mechanical cervical ripening with balloon devices is common during induction of labor; however, there is risk for displacement of the fetal presenting part during its insertion. This study sought to investigate the clinical risk factors associated with an intrapartum presentation change from cephalic to noncephalic presentation after mechanical cervical ripening.

Study Design Data were obtained from the Consortium on Safe Labor, a multicenter retrospective study that abstracted detailed labor and delivery information from electronic medical records in 19 hospitals across the United States. All women with fetal cephalic confirmed position on admission undergoing induction of labor with mechanical cervical ripening were included. Women who had a cesarean delivery for noncephalic presentation were compared with women who had a vaginal delivery or cesarean delivery for other indications. Models were adjusted for nulliparity, multiple gestation, and gestational age.

Results A total of 3,462 women met inclusion criteria, with 1.3% (n = 46) having an intrapartum presentation change from cephalic to noncephalic presentation after mechanical cervical ripening. Those who had a cesarean delivery for an intrapartum presentation change were more likely to be nulliparous (82.6 vs. 65.4%, p = 0.01), less than 34 weeks' gestation (6.5 vs. 1.3%, p = 0.02), and have twins (6.5 vs. 1.2%, p = 0.02). In adjusted analysis, twins were associated with an increased odds of cesarean delivery for intrapartum presentation change (adjusted odds ratio [aOR]: 4.43; 95% confidence interval [CI]: 1.25–15.77), whereas multiparity reduced the odds (aOR: 0.38; 95% CI: 0.17–0.82).

Conclusion Nulliparity and multifetal gestation are associated with a cesarean delivery for an intrapartum presentation change after mechanical cervical ripening.

Key Points

  • Intrapartum presentation change after mechanical cervical ripening is low at 1.3%.

  • Nulliparity and multifetal gestation are associated with a cesarean delivery for presentation change.

  • There were no significant differences in neonatal morbidity by delivery status to delivery type.

Keywords

intrapartum presentation change - mechanical cervical ripening - cervical balloon - cesarean delivery


Publikationsverlauf

Eingereicht: 22. März 2022

Angenommen: 24. April 2023

Accepted Manuscript online:
26. April 2023

Artikel online veröffentlicht:
19. Mai 2023

© 2023. Thieme. All rights reserved.

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